In August the disease appeared in nearly every part of the city, and particularly in places where there was the greatest exhalation from foul gutters and common sewers.
In describing the disease, as it appeared this year, I shall take notice of its symptoms as they appeared in the blood-vessels, alimentary canal, the tongue, the nervous system, in the eyes, the lymphatic system, and the blood.
The subjects which furnished the materials for this history were not only private patients, but the poor in the city hospital, who were committed to the care of Dr. Physick and myself, by the board of health.
I. The pulse was, in many cases, less active in the beginning of this fever than in former years. It was seldom preternaturally slow. It resembled the pulse which occurs in the first stage of the common jail fever. Hæmorrhages were common about the fourth and fifth days, and generally from the gums, throat, or stomach.
II. The whole alimentary canal was much affected in most cases. Costiveness and a vomiting were general. The alvine discharges were occasionally green, dark-coloured, black, and natural. The black vomiting was more common this year than in former years, in all the forms of the fever. It was sometimes suspended for several days before death, and hopes were entertained of a recovery of patients in whom it had appeared. In a boy, at the city hospital, it ceased ten days before he died. It was sometimes succeeded by delirium or coma, but it more commonly left the patient free of pain, and in the possession of all the faculties of his mind.
III. The tongue was by no means an index of the state of the fever, as in the years 1793 and 1797. I saw several deaths, attended with a black vomiting, in which the tongue retained a natural appearance. This phenomenon at first deceived me. I ascribed it to such a concentration of the disease in the stomach and other vital parts, as to prevent its diffusing itself through the external parts of the system. We observe the effects of the same cause in a natural state of the skin, and in a natural appearance of the urine, in the most malignant forms of this fever.
IV. In the nervous system, the disease appeared with several new symptoms. A relation of Peter Field attempted to bite his attendants in the delirium of his fever, just before he died.